Provider Demographics
NPI:1619534567
Name:GLEN L BRUENJES DDS PLLC
Entity Type:Organization
Organization Name:GLEN L BRUENJES DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRUENJES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-493-4173
Mailing Address - Street 1:909 DAIRY ASHFORD RD STE 104
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-5306
Mailing Address - Country:US
Mailing Address - Phone:281-493-4173
Mailing Address - Fax:281-493-4388
Practice Address - Street 1:909 DAIRY ASHFORD RD STE 104
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-5306
Practice Address - Country:US
Practice Address - Phone:281-493-4173
Practice Address - Fax:281-493-4388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies